David A Turner1, Alan Schwartz2, Carol Carraccio3, Bruce Herman4, Pnina Weiss5, Jeanne M Baffa6, Patricia Chess7, Megan Curran8, Christiane Dammann9, Pamela High10, Deborah Hsu11, Sarah Pitts12, Cary Sauer13, Tandy Aye14, Jill Fussell15, Jennifer Kesselheim16, John Mahan17, Kathleen McGann18, Angie Myers19, Richard Mink20. 1. D.A. Turner is vice president of competency-based medical education, American Board of Pediatrics, Chapel Hill, North Carolina, and consulting professor, Duke University Medical Center, Durham, North Carolina. At the time this work was completed, he was associate professor, Duke University Medical Center, Durham, North Carolina. 2. A. Schwartz is the Michael Reese Endowed Professor of Medical Education, interim head, Department of Medical Education, and research professor, Department of Pediatrics, University of Illinois at Chicago College of Medicine, Chicago, Illinois. 3. C. Carraccio was vice president of competency-based medical education, American Board of Pediatrics, Chapel Hill, North Carolina at the time this work was completed. 4. B. Herman is professor and vice chair of education, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah. 5. P. Weiss is vice chair of education and associate professor, Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut. 6. J.M. Baffa is emeritus associate professor of pediatrics, Sidney Kimmel Medical College of Thomas Jefferson University, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware. 7. P. Chess is professor, University of Rochester Medical Center, Rochester, New York. 8. M. Curran is associate professor, Department of Pediatrics, University of Colorado-Denver, Denver, Colorado. 9. C. Damman is professor, Department of Pediatrics, Tufts Children's Hospital, Boston, Massachusetts. 10. P. High is professor, the Warren Alpert Medical School of Brown University, Providence, Rhode Island. 11. D. Hsu is professor, Department of Pediatrics, Section of Emergency Medicine, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas. 12. S. Pitts is assistant professor, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts. 13. C. Sauer is associate professor, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia. 14. T. Aye is associate professor, Department of Pediatrics, Stanford University School of Medicine, Stanford, California. 15. J. Fussell is professor, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas. 16. J. Kesselheim is associate professor, Department of Pediatrics, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, Massachusetts. 17. J. Mahan is professor, Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio. 18. K. McGann is vice chair of education and professor, Department of Pediatrics, Duke University Medical Center, Durham, North Carolina. 19. A. Myers is professor of pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri. 20. R. Mink is professor of pediatrics, The David Geffen School of Medicine at University of California Los Angeles (UCLA) and The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California.
Abstract
PURPOSE: Entrustable professional activities (EPAs) are one approach to competency-based medical education (CBME), and 7 EPAs have been developed that address content relevant for all pediatric subspecialties. However, it is not known what level of supervision fellowship program directors (FPDs) deem necessary for graduation. The Subspecialty Pediatrics Investigator Network (SPIN) investigated FPD perceptions of the minimum level of supervision required for a trainee to successfully graduate. METHOD: In 2017, SPIN surveyed all FPDs of accredited fellowships for 14 subspecialties. For each EPA, the minimum supervision level for graduation (ranging from observation only to unsupervised practice) was set such that no more than 20% of FPDs would accept a lower level. RESULTS: The survey response rate was 82% (660/802). The minimum supervision level for graduation varied across the 7 EPAs from 2 (direct) to 4 (indirect for complex cases), with significant differences between EPAs. The percentage of FPDs desiring a lower minimum supervision level ranged from 3% to 17%. Compared with the 4 nonclinical EPAs (quality improvement, management, lead within the profession, scholarship), the 3 clinical EPAs (consultation, handover, lead a team) had higher minimum supervision graduation levels (P < .001), with less likelihood that an FPD would graduate a learner below their minimum level (P < .001). CONCLUSIONS: Consensus among FPDs across all pediatric subspecialties demonstrates the potential need for ongoing supervision for graduates in all 7 common pediatric subspecialty EPAs after fellowship. As CBME programs are implemented, processes and infrastructure to support new graduates are important considerations for leaders.
PURPOSE: Entrustable professional activities (EPAs) are one approach to competency-based medical education (CBME), and 7 EPAs have been developed that address content relevant for all pediatric subspecialties. However, it is not known what level of supervision fellowship program directors (FPDs) deem necessary for graduation. The Subspecialty Pediatrics Investigator Network (SPIN) investigated FPD perceptions of the minimum level of supervision required for a trainee to successfully graduate. METHOD: In 2017, SPIN surveyed all FPDs of accredited fellowships for 14 subspecialties. For each EPA, the minimum supervision level for graduation (ranging from observation only to unsupervised practice) was set such that no more than 20% of FPDs would accept a lower level. RESULTS: The survey response rate was 82% (660/802). The minimum supervision level for graduation varied across the 7 EPAs from 2 (direct) to 4 (indirect for complex cases), with significant differences between EPAs. The percentage of FPDs desiring a lower minimum supervision level ranged from 3% to 17%. Compared with the 4 nonclinical EPAs (quality improvement, management, lead within the profession, scholarship), the 3 clinical EPAs (consultation, handover, lead a team) had higher minimum supervision graduation levels (P < .001), with less likelihood that an FPD would graduate a learner below their minimum level (P < .001). CONCLUSIONS: Consensus among FPDs across all pediatric subspecialties demonstrates the potential need for ongoing supervision for graduates in all 7 common pediatric subspecialty EPAs after fellowship. As CBME programs are implemented, processes and infrastructure to support new graduates are important considerations for leaders.